Present situation and reform of rural medical security system
The rural medical security system is a comprehensive medical security system, which is regulated and supervised by the government through system design and maintenance, fund raising and management, health maintenance, etc., to ensure rural residents to obtain basic medical care and preventive health care services. After the reform and opening up, with the rapid development of China's economy, China's construction in all aspects has gradually improved, but China's social security development is relatively slow, especially rural medical security. There are nearly 900 million farmers in China, but the problem of such a huge population that it is difficult to see a doctor has not been completely solved, which will seriously affect the stability of rural society and the healthy development of economy and become the bottleneck of building a well-off society in an all-round way and building a harmonious socialist society. This paper will discuss the reform measures from the current situation of rural medical insurance system.
First, the development of rural medical security system
After the founding of New China, the Party and the government attached great importance to people's health and strongly supported the development of rural medical and health undertakings. Although the economy in most areas is relatively backward, with the direct administrative intervention of governments at all levels, agricultural cooperation and the rise of people's communes, cooperative medical care has been rapidly established in the vast rural areas since 1955. "By the end of 1970s, medical insurance covered almost all the urban population and 85% of the rural population. This is an unparalleled achievement for low-income developing countries. " By the end of 1980, 90% of the production teams in China had implemented cooperative medical care. However, after 1980s, with the cancellation of "People's Commune", the implementation of household contract responsibility system and the reduction of collective economic components, the cooperative medical system has experienced a serious decline. By 1985, the number of rural grass-roots units implementing cooperative medical care dropped sharply from 90% (production brigade) to 5% (administrative village).
1997 1, the State Council proposed "actively and steadily developing and improving the rural cooperative medical system", and in March of the same year, the Ministry of Health submitted "Several Opinions on Developing and Improving the Rural Cooperative Medical System" to the State Council. The development of rural cooperative medical care reached a small climax in 1998. "12.56% of rural residents in China have received different degrees of medical insurance, and 6.5% of residents have received cooperative medical insurance." However, "the proportion of out-of-pocket medical care for urban residents still accounts for 44. 13%, and that for rural residents is as high as 87.44%." After 1998, the cooperative medical system entered a downturn again.
Since 2003, with the proposal of governing for the people, putting people first and building a harmonious society, the government and all walks of life have fully realized the great significance of carrying out the pilot work of the new rural cooperative medical system. Driven by the relevant policies of the central government and the State Council, the pilot work of the new rural cooperative medical system has been solidly, actively and steadily promoted and achieved remarkable results. In 2006, the State Council forwarded the "Notice on Accelerating the Pilot Work of the New Rural Cooperative Medical System" jointly issued by the Ministry of Health and other seven ministries, proposing that "by 2006, the number of pilot counties (cities, districts) in China will reach about 40% of the total number of counties (cities, districts) in China; In 2007, it expanded to about 60%; In 2008, it was basically implemented nationwide; In 20 10, the new rural cooperative medical system will basically cover rural residents.
2007 is a crucial year for the new rural cooperative medical system to shift from the pilot stage to the comprehensive promotion stage. The Inter-ministerial Joint Conference of New Rural Cooperative Medical System in the State Council decided that from 2007, the national new rural cooperative medical system will enter the comprehensive promotion stage from the pilot stage, covering more than 80% of counties (cities, districts) in China.
Second, the status quo of China's rural medical security system
At present, although the per capita income of rural residents has increased, it cannot solve the expensive medical expenses, and the medical conditions in rural areas are still very severe. Mainly in the following aspects:
First, rural medical conditions. Most township (town) hospitals in China have dilapidated houses and lack basic medical equipment. A considerable number of health technicians have low qualifications and lack necessary professional medical knowledge, which leads to unnecessary medical accidents. In 2002, more than 580,000 new cases of tuberculosis were reported nationwide, 80% of which were in rural areas. The prevention and treatment of endemic diseases such as schistosomiasis, endemic fluorosis, Kaschin-Beck disease, iodine deficiency disease and Keshan disease in rural areas are facing new challenges. Due to the backward economy and poor medical conditions in these epidemic areas, the sick people can't get timely and effective treatment, which seriously affects their production and life and hinders the local social and economic development.
Second, the cost of rural medical security. Due to the intensification of environmental pollution in rural areas, the influence of unhealthy lifestyles, the widening income gap between urban and rural areas, the rapid rise of medical expenses and the change of disease spectrum, farmers have been unable to cope with disease risks together with their families. According to 1998 national health service survey, 87.4% of farmers in China pay their own expenses. Due to financial difficulties, they were unable to pay medical expenses, and the average hospitalization expenses of 37% sick farmers reached 1532 yuan. According to the annual sampling survey of the National Bureau of Statistics, the per capita net income of 33.5% farmers in China was lower than 1.500 yuan, and the net income of farmers in 6 provinces (autonomous regions and municipalities directly under the Central Government) was lower than 1.500 yuan. Once a farmer is hospitalized, his annual income is not enough. In some poor rural households, the proportion of poverty caused by illness and returning to poverty due to illness is as high as 50%, which has become one of the restrictive factors affecting rural economic development and farmers' poverty alleviation. At present, the rural medical security costs are paid by the government, and it is a bit reluctant to rely entirely on government finances, but now the medical expenses are rising. The shortage of funds is a major bottleneck in rural medical security.
Third, the management of medical security system. It is difficult for the government to find out the medical condition of residents. As a result, some people need medical security but can't get the corresponding medical care, while some people who don't need it for the time being get too many medical care services, which inevitably leads to the phenomenon of abusing power for personal gain. Therefore, it is necessary for the personnel of government management agencies to supervise, which requires the establishment of an independent supervision organ, which can not only identify medical safety issues, but also identify whether there are violations. How to set up this supervisory body is another problem. The government wants to raise money and then use it. How much to raise, how much to use and where to use it? Even if the idea is used, if the effect is not ideal, public opinion will suspect that the funds have been misappropriated. It is precisely because of these problems that the government needs to supervise if it wants to use the funds raised only for medical security. In short, there are management defects in rural medical security, which cannot be managed by the government alone.
Third, the reform model of rural medical security system in China
In view of the above problems and defects of China's rural medical insurance system, the author thinks that the rural cooperative medical system is the most basic model at present and should be reformed appropriately. At present, rural medical cooperation has two main characteristics: private and public assistance; private. Farmers who participate in rural cooperative medical care pay certain health care fees; Rural cooperative medical care funds mainly come from the collective economy and the public welfare fund of the collective economy;
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